What causes a retroperitoneal hematoma?

From the Guidelines

A retroperitoneal hematoma is primarily caused by trauma, blood vessel disorders, or medication complications, as evident from the most recent study published in 2021 1. The causes of a retroperitoneal hematoma can be categorized into several key areas, including:

• Trauma: Blunt or penetrating trauma to the abdomen or lower back can damage blood vessels or organs in the retroperitoneal space, leading to bleeding, as noted in the study published in the Journal of the American College of Radiology 1.
• Blood vessel disorders: Conditions such as aneurysms of the aorta or renal arteries can increase the risk of retroperitoneal bleeding, as mentioned in the study 1.
• Medication complications: Patients taking anticoagulant medications like warfarin, heparin, or direct oral anticoagulants (DOACs) such as apixaban or rivaroxaban are at increased risk of spontaneous retroperitoneal hematomas, especially when dosed inappropriately, as highlighted in the study 1. Other potential causes of retroperitoneal hematoma include:
• Medical procedures: Kidney biopsies, lumbar punctures, or vascular interventions can sometimes cause retroperitoneal bleeding, as noted in the study 1.
• Tumors: Tumors in the retroperitoneal space may bleed spontaneously or after minor trauma, as mentioned in the study 1.
• Bleeding disorders: Patients with bleeding disorders like hemophilia are also at increased risk of retroperitoneal bleeding, as highlighted in the study 1. The retroperitoneal space contains loosely packed fatty tissue with numerous blood vessels and vital organs, including the kidneys, parts of the pancreas, adrenal glands, and major blood vessels like the aorta and inferior vena cava, making bleeding in this area potentially serious and sometimes difficult to detect early, as evident from the study published in 2021 1.

From the Research

Causes of Retroperitoneal Hematoma

• Retroperitoneal hematomas (RPH) can occur due to various causes, including:
  • Blunt trauma 2, 3, 4, 5
  • Penetrating trauma 2, 3, 4
  • Spontaneous occurrence, especially in the elderly and patients using anticoagulants 2
  • Percutaneous intervention, such as transfemoral percutaneous procedures 6
• The location of the hematoma can also vary, with zones I, II, and III being commonly affected 2, 4, 5
• Additional factors, such as multiple musculoskeletal injuries, intra-abdominal injuries, and abnormal coagulation, can contribute to the development of extensive retroperitoneal hematomas 5

Risk Factors and Associated Injuries

• Risk factors for retroperitoneal hematomas include:
  • Age, with the elderly being more susceptible to spontaneous RPH 2
  • Use of anticoagulants, which can increase the risk of spontaneous RPH 2
  • Presence of additional injuries, such as pelvic fractures, lumbar spine fractures, and genitourinary injuries 3, 4, 5
• Associated injuries can also impact the management and outcome of retroperitoneal hematomas, with factors such as:
  • Injury severity score (ISS) 5
  • Coagulation profile 5
  • Presence of chest injuries 5

Management and Outcome

• The management of retroperitoneal hematomas can vary depending on the cause, location, and severity of the injury, as well as the presence of associated injuries 2, 3, 4, 5
• Surgical treatment may be necessary in some cases, especially for patients with penetrating trauma or those who are hemodynamically unstable 2, 4
• The outcome of retroperitoneal hematomas can be affected by various factors, including the severity of the injury, the presence of associated injuries, and the timeliness and effectiveness of treatment 2, 3, 4, 5